THIS FORM SHOULD NOT BE FILED WITH THE COURT FL-142 ...

THIS FORM SHOULD NOT BE FILED WITH THE COURT

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name and Address):

TELEPHONE NO.:

FL-142

ATTORNEY FOR (Name):

SUPERIOR COURT OF CALIFORNIA, COUNTY OF

PETITIONER: RESPONDENT:

SCHEDULE OF ASSETS AND DEBTS

Petitioner's

Respondent's

CASE NUMBER:

-- INSTRUCTIONS -- List all your known community and separate assets or debts. Include assets even if they are in the possession of another person, including your spouse. If you contend an asset or debt is separate, put P (for Petitioner) or R (for Respondent) in the first column (separate property) to indicate to whom you contend it belongs.

All values should be as of the date of signing the declaration unless you specify a different valuation date with the description. For additional space, use a continuation sheet numbered to show which item is being continued.

ITEM NO.

ASSETS DESCRIPTION

1. REAL ESTATE (Give street addresses and attach copies of deeds with legal descriptions and latest lender's statement.)

SEP. PROP

CURRENT GROSS AMOUNT OF MONEY

DATE

FAIR MARKET

OWED OR

ACQUIRED

VALUE

ENCUMBRANCE

$

$

2. HOUSEHOLD FURNITURE, FURNISHINGS, APPLIANCES (Identify.)

3. JEWELRY, ANTIQUES, ART, COIN COLLECTIONS, etc. (Identify.)

Form Approved for Optional Use Judicial Council of California FL-142 [Rev. January 1, 2005]

SCHEDULE OF ASSETS AND DEBTS (Family Law)

Page 1 of 4 Code of Civil Procedure, ?? 2030(c), 2033.5

ITEM NO.

ASSETS DESCRIPTION

SEP. PROP

4. VEHICLES, BOATS, TRAILERS (Describe and attach copy of title document.)

CURRENT GROSS AMOUNT OF MONEY

DATE

FAIR MARKET

OWED OR

ACQUIRED

VALUE

ENCUMBRANCE

$

$

5. SAVINGS ACCOUNTS (Account name, account number, bank, and branch. Attach copy of latest statement.)

6. CHECKING ACCOUNTS (Account name and number, bank, and branch. Attach copy of latest statement.)

7. CREDIT UNION, OTHER DEPOSIT ACCOUNTS (Account name and number, bank, and branch. Attach copy of latest statement.)

8. CASH (Give location.)

9. TAX REFUND

10. LIFE INSURANCE WITH CASH SURRENDER OR LOAN VALUE (Attach copy of declaration page for each policy.)

FL-142 [Rev. January 1, 2005]

SCHEDULE OF ASSETS AND DEBTS (Family Law)

Page 2 of 4

ITEM NO.

ASSETS DESCRIPTION

11. STOCKS, BONDS, SECURED NOTES, MUTUAL FUNDS

(Give certificate number and attach copy of the certificate or

copy of latest statement.)

SEP. PROP

CURRENT GROSS AMOUNT OF MONEY

DATE

FAIR MARKET

OWED OR

ACQUIRED

VALUE

ENCUMBRANCE

$

$

12. RETIREMENT AND PENSIONS (Attach copy of latest summary plan documents and latest benefit statement.)

13. PROFIT - SHARING, ANNUITIES, IRAS, DEFERRED COMPENSATION (Attach copy of latest statement.)

14. ACCOUNTS RECEIVABLE AND UNSECURED NOTES (Attach copy of each.)

15. PARTNERSHIPS AND OTHER BUSINESS INTERESTS (Attach copy of most current K-1 form and Schedule C.)

16. OTHER ASSETS

17. TOTAL ASSETS FROM CONTINUATION SHEET

$ 18. TOTAL ASSETS

FL-142 [Rev. January 1, 2005]

SCHEDULE OF ASSETS AND DEBTS (Family Law)

$

Page 3 of 4

ITEM NO.

DEBTS--SHOW TO WHOM OWED

19. STUDENT LOANS (Give details.)

20. TAXES (Give details.)

SEP.

TOTAL

PROP OWING

$

DATE INCURRED

21. SUPPORT ARREARAGES (Attach copies of orders and statements.)

22. LOANS--UNSECURED (Give bank name and loan number and attach copy of latest statement.)

23. CREDIT CARDS (Give creditor's name and address and the account number. Attach copy of latest statement.)

24. OTHER DEBTS (Specify.):

25. TOTAL DEBTS FROM CONTINUATION SHEET

26. TOTAL DEBTS

$

27.

(Specify number):

pages are attached as continuation sheets.

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date:

(TYPE OR PRINT NAME) FL-142 [Rev. January 1, 2005]

(SIGNATURE OF DECLARANT)

SCHEDULE OF ASSETS AND DEBTS (Family Law)

Page 4 of 4

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